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(J2) CPR II Test 1 (Cardiovascular) > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What factors affect blood pressure?

A

BP = cardiac output X peripheral resistance

Cardiac output:

  • blood volume (Na+, mineralocorticoids, ANP)
  • HR
  • contractility

Peripheral resistance:

  • arteriole constriction (angiotensin, catecholamines, α-adrenergics, leukotrienes, endothelin)
  • arteriole dilation (NO, β-adrenergics)
  • pH
  • autoregulation
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2
Q

What blood pressures are indicative of HTN?

Severity?

A

Stage 1 HTN:

  • systolic 130-139
  • diastolic 80-89

Stage 2 HTN:

  • systolic >140
  • diastolic >90

Hypertensive crisis/malignant HTN:

  • systolic >180
  • diastolic >120

Hypertensive emergency:

-hypertensive crisis w/ end organ failure (kidney, heart, and brain/eyes)

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3
Q

What is primary HTN?

What are risk factors?

A

HTN due to multifactorial causes, not a specific condition

-~90% of HTN

Non-modifiable risk factors:

  • age
  • ethnicity (AA)
  • family history

Modifiable risk factors:

  • obesity
  • DM
  • smoking
  • excess salt intake (Na+)
  • inactivity
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4
Q

What is secondary HTN?

What are causes?

A

HTN that can be attributed to a specific cause

Renal:

  • renovascular disease
  • renal artery stenosis

Endocrine causes:

  • primary hyperaldosteronism (Conn syndrome); most common secondary HTN cause
  • hypercortisolism (Cushing syndrome)
  • pheochromocytoma
  • Coarctation of the aorta
  • Estrogen
  • Treatment (glucocorticoids)

*RECENT*

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5
Q

How does HTN due to hyperaldosteronism present?

A

HTN w/ hypokalemia

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6
Q

How does aldosterone affect blood pressure?

A

part of Renin-Angiotensin-Aldosterone system (RAAS)

renin released from kidney in response to low volume or low sodium

aldosterone -> reabsorption of Na+ (secretion of K+ in exchange) -> water retention

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7
Q

What are causes of primary hyperaldosteronism?

A
  • idiopathic (adrenal excess production)
  • adrenal adenoma
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8
Q

How does HTN due to hypercortisolism present?

A

HTN w/ cushingoid features

  • round face
  • stretch marks/purple striae
  • central obesity
  • hyperglycemia
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9
Q

How does cortisol affect blood pressure?

A

weak mineralcorticoid (aldosterone) effect in the kidney

  • sodium reabsorption -> water retention
  • potassium excretion
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10
Q

How does HTN due to a pheochromocytoma present?

A

HTN w/ adrenergic symptoms

  • tachycardia
  • palpitations
  • diaphoresis
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11
Q

How does a pheochromocytoma affect blood pressure?

A

catecholamine (epi/norepi) secreting adrenal tumor

β-1 effects -> increased cardiac output

α-1 effects -> increased preipheral resistance (arteriole constriction)

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12
Q

How does HTN due to renal artery stenosis present?

A

HTN w/ signs of renal disease

  • decreased GFR
  • increased creatinine

Abdominal bruit with renal artery stenosis

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13
Q

What are causes of renal artery stenosis?

A
  • atherosclerosis
  • fibromuscular dysplasia (beads on a string)
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14
Q

How does renal artery stenosis affect blood pressure?

A

decreases blood flow to kidney -> renin release

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15
Q

What is coarctation of the aorta?

How does it cause HTN?

A

narrowing of the aorta at ligamentum arteriosum -> increased peripheral resistance in the distal aortic arch (distal to L subclavian A.) -> increased BP in upper extremities, head, and neck w/ decreased BP elsewhere (ie. lower extremities)

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16
Q

What conditions are commonly associated with coarctation of the aorta?

A
  • bicuspid aortic valve
  • Turner syndrome (XO)
17
Q

How does HTN due to coarctation of the aorta present?

A
  • HTN in the upper extremities
  • hypotension in the lower extremities
18
Q

What are complications of HTN?

A

Cardiac:

-hypertrophy -> congestive heart failure -> pulmonary edema (cough/dyspnea)

Kidney:

-renal dysfunction -> increased creatinine/proteinuria

Brain/Eye:

  • CVA/stroke
  • prolonged HTN -> chronically increased intracranial pressure -> hypertensive retinopathy
  • Hypertensive crisis -> acutely increased intracrainal pressure -> papilledema
19
Q

What vascular histologic changes are seen in HTN?

A
  • hyaline arteriolosclerosis
  • hyperplastic arteriolosclerosis
20
Q

What is hyaline arteriolosclerosis?

(cause)

How does it affect the kidney?

A

chronic (benign) HTN -> smooth muscle synthesis + protein leak

homogenous, pink thickening of the vessel wall -> narrowing of lumen

Kidney:

-decreased renal blood flow (narrowing of renal artery lumen) -> granular arteriosclerotic kidney (roughened appearance due to fibrosis due to ischemia)

21
Q

What is hyperplastic arteriolosclerosis?

(cause)

How does it affect the kidney?

A

hypertensive crisis (malignant HTN) -> lamellation of the vessel wall, “onion skinning” w/ fibrinoid deposits and necrosis (necrotizing arteriolitis)

Kidney:

-severe increased in BP -> multiple hemorrhages

(J2) CPR II Test 1 (Cardiovascular) (18 decks)

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